Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2012 -00267
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/09/2013
T [G AR L�.: g Parcel: 2S 101 AD00400
Jurisdiction: Tigard
Site address: 6665 SW HAMPTON ST 100
Project: Hampton Oaks Subdivision: WEST PORTLAND HEIGHTS Lot: 14 -31, P
Project Description: Low voltage for HVAC
Contractor: AMERICAN HEATING INC Owner: HAMPTON OAKS LLC
1339 SE GIDEON ST 6665 SW HAMPTON
PORTLAND, OR 97202 2ND FLOOR
TIGARD, OR 97223
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
FEES
- Description Date Amount
Specifics: Restricted Energy Permit 01/09/2013 $75.00
12% State Surcharge - Electrical 01/09/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
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Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth ' OAR
952 -001 -0010 through OAR 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 or 1.800.332
7 L Issued By: y f -Q / j Permittee Si nature: ! �C e �
"' L 9
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each Inspection.
Electrical Permit Appli EIVED FOR OFFICE USE ONLY - . •
City of Tigard 3 2012 Received /R 3 / Permit No.: f /L�?D/42 -QQ2
13125 SW Hall Blvd., Tigard, OR Plan Review
' I Phone: 503.639.4171 Fax: 503.598 1 6F T 11 P "' D : Other Permit:
T I G A R D Inspection Line: 503.639.4175 C1 Date Ready/By: ions: ® See Page 2 for
Internet: www.tigard-or.gov -0 itDiti v G` DIVIS Notified/Method: Supplemental Information
X` .'��`• __ - - ' ems. x.- : i:A . -'•n4140,240.- :; S "a C - �„u:_ :?' _ _ •
❑ New construc C A dd i t i on/alterat i on/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
;; _ 1'^'bBn:C( STR N`� " z exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
TED l ION''';':;`
" - "' ' °- -" '' " ` ` - less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El and 2- family dwelling ^ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
!T _ - d.k,.- > °.5:,- �, �.:: -:: - - -_ T - _ - _ ❑ Emergency system. larger separately derived system.
-c
n`70Bt5 ci O .i:4N1i`~ 'Oftefiff '
-- - - _ � - - - - .. Addition of new motor load of ❑ "A" "E" "I.2" "I -3"
Job no.: Job site address: 06 5 5 W FA vii Pioti S' f . 100HP or more. occupancy.
❑
f ❑Six or more residential units. Recreational vehicle parks.
❑ Health-care facilities. ❑ Supply voltage for more than
City/State /ZIP: % G1 i d 9� Z2
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Servicee or feeder 600 amps or m 1�y
Cross street/directions to job site: _ Description I qtr. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
k� __�: f. a, _ Limited energy, residential 67.84 2
he:
0E+j'V :4,k- ', ' r :.i� ` = _:; = _'�' (with above s . fi')
Jo , , Limited energy, multi - family 67.84 2
i v
V o I � e i I n Q residential (with above sq. ft.)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
%Y' OPERT Rv �._' . „ :�, >;�` �: == : ' .
� - -.`� :.,� , ~ Yr;;.O,y4rl�E _, < ,I; -❑ 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 l
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701; 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
appp ' � ^s� - - _`tC7�zCONT��i�fi A RE :>ttS'[��N,�
above service or feeder fee,
. .. �, w r " >�.; -s - 742 2
-::. r�-::.,,....., ..,- :__ .._. . _ -., ,.:.., �:,:,. .- ._.... >..r.� +,- r.- .. ,..... . , .
Business name: L' each branch circuit
Arne r Ica h Hem ) B . Fee for branch circuits
r3 ral eJ / 4 3n e /2 e s T e 1'' B. without or feeder fee
Contact name: first t branch circuit 56.18 2
Address: /33(3 S E 1 rJ eon J C E ach add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Po (' -f - J a S 0 R C 7 2 0 Z Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: (503 )231 - 1J(p D 0 Fax: : (SoY)Z39 -7 03 S Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
Si or outline lighting 67.84 2
�' - • O s�� - g g
.,- .._.,-- :rte...:- r..�s_c_ a,a,.f .. - '
Business name:A� yj CC C� eq t /� ` I Signal circuit(s) or limited -
energy panel, alteration, or
Address: /331 5E 6 ( cl e O/1 S extension. Describe: Page 2 76- 2
City/State/ZIP: f r-1-- / 0 972 02, Each additional inspection over allowable in any of the above
Per
Phone: (503)23/ 1 /f OO Fax: (So 3) Z31 Investigation 8 estigagattion ion 66.25
per hour (t hr min) 66.25
CCB Lic.: 33 13 5 Electrical Lic.:2 0 993 (..gE Suprv. Lic.: 2 (OLIO L Eg Industrial plant per hour 78.18
:,` _ ?_, LE CTR_ICikiFf RM T FEES = - ' :
.,`
Suprv. Electrician signature, require'dr�� _ .. -1 -- ------ Subtotal: '75 - ` c
Print name:T S I C V e y C`J V 11, Date: 12 2 D `2 Plan review (25% of permit fee): —
/ State surcharge (12% of permit fee): g .
Authorized signature: 2? Z'' L TOTAL PERMIT FEE: g 4 oU
Print name:g, (f l// Date: This application expires if a permit is not obtained within 180
G �S �el� /� /p? p ermit days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitAppdoc 10/01/09 440 -461 ST(I I /05 /COM/WEB